Reproductive Issues Research Articles

Reproductive Assessment: Findings from 20 Years of the Tehran Lipid and Glucose Study.

ContextReproductive domains of the Tehran lipid and glucose study (TLGS) are unique in that they provide reliable information on reproduction of an urban population of West Asia. The aim of this review is to present the most important reproductive findings of TLGS.Evidence AcquisitionThis review is summarizing all articles published in the context of reproductive aspects of TLGS results over the 20-year follow-up. A comprehensive databases search was conducted in PubMed (including Medline), Web of Science and Scopus for retrieving articles on the reproductive histories in context of the TLGS.ResultsThe mean (SD) age at menarche and menopause was 13 (1.2) and 49.6 (4.5) years respectively. While pills were the most commonly used modern methods at the initiation of TLGS, the prevalence of condoms rose sharply and significantly over the follow up duration. Among women with history of gestational diabetes, the risk of diabetes and dyslipidemia progression were 2.44 and 1.2 fold higher than others. Prevalences of PCOS and idiopathic hirsutism among reproductive age participants of TLGS were 8.5% (95% CI: 6.8% - 10.2%) and 13.0% (95% CI: 10.9% - 15.1%), respectively. Trend of cardio-metabolic risk factors among women with PCOS showed that there were no statistically significant differences between mean changes of each cardio metabolic variables between PCOS and healthy women; PCOS status also significantly associated with increased hazard of diabetes and prediabetes among women aged younger than 40 years (HR: 4.9; 95% CI: 2.5 - 9.3, P value < 0.001)) and (HR: 1.7; 95% CI: 1.1 - 2.6), P value < 0.005), respectively.ConclusionsThe population based nature of TLGS provides a unique opportunity for valid assessment of reproductive issues, the results of which could provide new information for modification of existing guidelines.

Psychosocial situation in adults with congenital heart defects today and 20 years ago: Any changes?

BackgroundWhile diagnosis and treatment of congenital heart diseases have improved over the last two decades, data regarding the course of psychosocial parameters is missing. MethodsIn a cross-sectional study, 283 adults with congenital heart disease completed a slightly modified questionnaire that was applied in a comparable study twenty years ago. Significant differences between the two populations as well as possible predictors of psychosocial burden for the recent population were sought. ResultsDespite the presence of more complex heart defects in the current cohort (p < 0.001), both populations exhibited similar values in the Ability Index. Furthermore, the current cohort reported significantly improved outcomes regarding school performance, employment, and sports. Regarding psychosocial functioning, the current cohort showed better outcomes in the domains of sadness (p < 0.01), independence (p < 0.01), understanding (p < 0.001), and acceptance (p < 0.01) of heart disease. Predictors for a worse psychosocial situation in a multiple regression analysis were anxiety, lack of curiosity, and age over 33. In the current study women, as opposed to men, reported significantly more dissatisfaction with too little information provided about their illness (p < 0.05), higher anxiety levels (p < 0.01), and heightened illness-connected burden (p < 0.05). However, women showed higher levels of independence (p < 0.01) and lower alcohol consumption (p < 0.001). ConclusionThe psychosocial situation of adults with congenital heart disease has improved over the span of 20 years. However, particular needs and concerns should be addressed individually via doctor-patient communication. The findings here suggest that especially female patients appear to have a higher demand for counselling information, e.g. reproduction issues.

Knowledge of neurologists and gynaecologists regarding reproductive and maternity issues in women with epilepsy

Background: Epilepsy is one of the most common neurological disorders, with more than 400,000 individuals in Poland (about 1% of the population) affected. Epilepsy complicates approximately 0.5% of pregnancies. Objective: To determine the level of knowledge that neurologists and gynaecologists have about reproductive and maternity issues for women with epilepsy. Material and methods: This study included 141 neurologists and physicians undergoing specialist training in neurology as well as 72 gynaecologists and physicians undergoing specialist training in gynaecology. A validated questionnaire was used to survey these neurologists and gynaecologists, who worked in Silesia Province. Results: In the group of physicians advising on contraception, significantly (p=0.003) more gynaecologists than neurologists recommended hormonal birth control. Significantly more (p=0.031) neurologists than gynaecologists believed that monotherapy with antiepileptic medications should be aimed for before a planned pregnancy in women with epilepsy. More than a half of the surveyed physicians (56.8%) believed that pregnant women with epilepsy can have a natural delivery. Conclusions: On the basis of these results, we have concluded that gynaecologists and, to a lesser extent, neurologists should have more extensive knowledge regarding reproductive and maternity issues for women with epilepsy. We further propose that close collaboration between neurologists and gynaecologists in the care of epileptic women is necessary.

Systemic lupus erythematosus: what should family physicians know in 2018?

Systemic lupus erythematosus (SLE) is a complex multi-systemic autoimmune disease with considerable clinical and immunological heterogeneity. Family physicians should be familiar with the protean manifestations of SLE to aid early diagnosis and monitoring of disease progression. The role of family physicians in SLE includes education, counselling, psychological support, management of mild disease, and recognition of the need for referral to other specialists for more serious disease and complications. Surveillance of cardiovascular risk factors and osteoporosis and advice about vaccination and reproductive issues can be performed in the primary care setting under close collaboration with rheumatologists and other specialists. This review provides family physicians with the latest classification criteria for SLE, recommendations on SLE-related health issues, and pharmacological therapies for SLE.

Adolescent-parent communication on sexual and reproductive health issues and associated factors among high school students in Woldia town, Northeastern Ethiopia.

IntroductionSexual and reproductive health (SRH) communication is most likely to promote healthy sexual practices and to reduce risky sexual behavior among adolescents. Communication is the principal means for parents to transmit sexual values and knowledge to their children. This study aimed to assess adolescent-parent communication on SRH issues among high school students in Woldia town.MethodsA cross-sectional study was conducted from December 15-31, 2016. Systematic random sampling technique was used to select 693 students from Grades 9 and 10. Data were entered into Epi-info version 3.5.1 and analyzed by using SPSS version 20. Logistic regression with Odds Ratios (OR) and 95% Confidence intervals (CI) was used to identify the independent predictors of adolescent-parent communication.Results674 students accepted to participate in this study giving a response rate of 97.3%. Only 205(30.4%) had discussed on two or more SRH topics with their parents. In logistic regression analyses, mothers who could read and write [AOR=2.0; 95% CI=1.3-3.1] and had diploma certificate [AOR=2.0; 95% CI=1.4-2.9] were more likely to discuss on SRH issues with their children. Adolescents who agreed on the importance of discussion on SRH issues [AOR=2.5; 95% CI=1.3-4.5], whoever got SRH information [AOR=2.0; 95% CI=1.4-2.9] and those whoever had sexual intercourse [AOR=1.7; 95% CI=1.1-2.6] were more likely to discuss on different SRH issues with their parents.ConclusionThis study revealed that parent-adolescent communication on SRH issues was inadequate. Therefore, there is a need to equip and educate parents on different adolescents' SRH issues.

Pharmacological Approach to Managing Childhood-Onset Systemic Lupus Erythematosus During Conception, Pregnancy and Breastfeeding.

Pediatric patients often have poor pregnancy outcomes. Systemic lupus erythematosus predominantly impacts women in their second to fourth decade of life, with childhood-onset disease being particularly aggressive. Reproductive issues are an important clinical consideration for pediatric patients with systemic lupus erythematosus (SLE), as maintaining good disease control and planning a pregnancy are important for maternal and fetal outcomes. In this clinical review, we will consider the safety of medications in managing childhood-onset SLE during conception, pregnancy, and breastfeeding. The developing fetus is at highest risk for teratogenicity from maternal medications during the period of critical organogenesis, which occurs between the first 3-8weeks following conception. Medications known to be teratogenic, leading to a specific pattern of malformations, include mycophenolic acid, methotrexate, and cyclophosphamide. These should be discontinued prior to a planned pregnancy or as soon as pregnancy is suspected. Hydroxychloroquine is safe and should be continued throughout pregnancy and breastfeeding in those without contraindications to it. Azathioprine and calcineurin inhibitors are felt to be compatible with pregnancy in usual doses and may be used prior to and throughout pregnancy and lactation. Non-fluorinated corticosteroids including methylprednisolone and prednisone are inactivated by the placenta and can be used if needed for maternal indication during gestation. Addition of aspirin may be considered around the 12th week of gestation for prevention of pre-eclampsia. Illustrative cases are presented that demonstrate management of adolescents with childhood-onset SLE through conception, pregnancy, and breastfeeding.

The assessment of testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI) in couples of post chemotherapy non-obstructive azoospermia (NOA)

Advances in chemotherapeutic treatments can achieve high remission rates in pediatric and adolescent patients with cancer, but cytotoxic chemotherapy may lead to irreversible spermatogenic dysfunction. In cancer survivors, the restoration of fertility and achievement of paternity have become important concerns, however, at diagnosis, patients with such serious diseases are often not concerned with reproductive issues. A retrospective study in a reproductive center. We evaluated sperm retrieval rate (SRR) of microdissection TESE (micro TESE), two pronuclei (2PN) oocyte rates, blastocyst development rates, good-quality blastocyst (Grade 3BB and above on day 5 by the Gardner scoring) rates, and clinical pregnancy rates per embryo transfer (ET) in 44 cases with post chemotherapy NOA patinets (including 8 patients with bone marrow transplantation (BMT)), 330 NOA cases with 46,XY without past history (unexplained NOA; not including after orchidopexy, Klinefelter syndrome, cryptozoospermia, mumps orchitis, etc), and 107 cases with obstructive azoospermia (OA) between September 2013 and April 2018. The cancer types included testicular cancer, colon cancer, Hodgkin's lymphoma, non-Hodgkin's lymphoma, leukemia, neuroblastoma, and osteosarcoma. The age at micro TESE and chemotherapy was 33.9±5.4 and 17.3±10.4 years of age, respectively, and the wives age at ICSI was 33.7±3.9 years. SRR of micro TESE in post chemotherapy NOA (21/44=47.7%) was higher than unexplained NOA (92/330=27.9%) patients (P<0.01). In sperm retrieved post chemotherapy NOA, age at chemotherapy end was older (20.6±9.1 years) than failure group (14.2±10.8 years) (P<0.05). With respect to type of cancer, there was no predictor for SRR and no significant differences in the pregnancy and live birth rates. In 3 of 8 post BMT patients spermatozoa were successfully retrieved. Two of 3 patients even showed a 46,XX karyotype (transplantation from female donor). The 23 patients who failed to obtain sperm could not find any germ cells in their testicular samples in wet preparations and histopathological sections (Sertoli cell only syndrome). 2PN oocytes, blastocysts development, and good-quality blastocysts rates were 63.2%, 55.8%, and 61.9% in post chemotherapy NOA, 58.3%, 45.2%, and 37.8% in unexplained NOA, and 66.0%, 51.6%, and 42.8% in OA. Post chemotherapy NOA showed higher clinical pregnancy rates per ET (44.9%: 22/49) than unexplained NOA (26.2% : 37/141) (P<0.05). Fourteen children have been born and 4 patients are on going pregnancy in post chemotherapy NOA couples. Age at chemotherapy was important predictive factor for successful sperm recovery. Once sperm were obtained their reproductive performance was satisfactory. These findings provides hope for men of reproductive age who have not undergone sperm cryopreservation before chemotherapy.

Disruption of INOS, a Gene Encoding myo-Inositol Phosphate Synthase, Causes Male Sterility in Drosophila melanogaster.

Inositol is a precursor for the phospholipid membrane component phosphatidylinositol (PI), involved in signal transduction pathways, endoplasmic reticulum stress, and osmoregulation. Alterations of inositol metabolism have been implicated in human reproductive issues, the therapeutic effects of drugs used to treat epilepsy and bipolar disorder, spinal cord defects, and diseases including diabetes and Alzheimer’s. The sole known inositol synthetic enzyme is myo-inositol synthase (MIPS), and the homolog in Drosophilia melanogaster is encoded by the Inos gene. Three identical deletion strains (inosΔDF/CyO) were constructed, confirmed by PCR and sequencing, and homozygotes (inosΔDF/inosΔDF) were shown to lack the transcript encoding the MIPS enzyme. Without inositol, homozygous inosΔDF deletion fertilized eggs develop only to the first-instar larval stage. When transferred as pupae to food without inositol, however, inosΔDF homozygotes die significantly sooner than wild-type flies. Even with dietary inositol the homozygous inosΔDF males are sterile. An inos allele, with a P-element inserted into the first intron, fails to complement this male sterile phenotype. An additional copy of the Inos gene inserted into another chromosome rescues all the phenotypes. These genetic and phenotypic analyses establish D. melanogaster as an excellent model organism in which to examine the role of inositol synthesis in development and reproduction.

Circulating insulin-like peptide 5 levels and its association with metabolic and hormonal parameters in women with polycystic ovary syndrome.

Insulin-like peptide 5 (INSL5) is a gut peptide hormone that is a member of relaxin/insulin superfamily. Growing evidence implicates the crucial role of the peptide in some metabolisms including food intake, glucose homeostasis and reproductive system. Polycystic ovary syndrome (PCOS) is involved in both reproductive and metabolic issues. The aim of the study was determination of circulating levels of INSL5 alteration in women with PCOS and evaluation of the relationship between INSL5 and hormonal-metabolic parameters as well as carotid intima media thickness (cIMT). A total of 164 subjects were recruited in this cross-sectional study (82 women with PCOS and 82 age- and BMI-matched controls). Circulating INSL5 levels were assessed via ELISA method. High-resolution B-mode ultrasound was used to measure cIMT. The hormonal and metabolic parameters of the recruited subjects were determined. Circulating INSL5 levels were significantly elevated in women with PCOS compared to controls (27.63 ± 7.74 vs. 19.90 ± 5.85ng/ml, P < 0.001). The mean values of INSL5 were significantly higher in overweight subjects compared to lean weight subjects in both groups. The women with PCOS having insulin resistance have increased INSL5 compared to those of PCOS subjects without insulin resistance. INSL5 is associated with insulin resistance, BMI, luteinizing hormone and free androgen index. Multivariate logistic regression analyses revealed that the odds ratio for having PCOS in the highest tertile of INSL5 was higher than in the lowest tertile. PCOS subjects exhibited an elevation in circulating INSL5 levels along with a link between INSL5 level induction and metabolic-hormonal parameters.

Frequently asked questions of individuals with spinal cord injuries: results of a web-based consultation service in Iran.

Descriptive study of the results of a web-based consultation service for individuals with spinal cord injury (SCI). To review frequently asked questions (FAQ) among individuals with SCI and determine the most important topics. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. A cross-sectional study reviewing questions from patients with SCI that were collected from the Health and Safety Consultant Center (HSCC) between January and December 2015. The HSCC is a web-based medical consultation service that provides patients with information and counseling pertaining to SCI. A total of 113 questions were collected from 99 individuals. The mean age was 32.02 ± 13.28 years with a range of 3-70 years. Men accounted for 81.7% of the questions, while women accounted for 18.3%. The most common site of SCI was thoracic (40.6%), followed by lumbar (31.3%), and cervical (28.1%). Recovery potential (38.1%), sexual and reproductive issues (26.5%), urinary (10.6%), and motor (10.6%) problems were among the most commonly reviewed topics. FAQ provide insight on areas of concerns for individuals with SCI and help guide providers to determine high-yield topics. Discerning the specific areas of need or concern for patients is instrumental in developing pertinent educational materials and programs, in addition to efficiently counseling patients and caregivers on the aftercare of SCI.

Towards an Ethics of Assisted Human Reproduction

The paper Reproducerea umana medical asistata. Etica incriminarii versus etica biologica. Studiu de drept comparat is the only work of the Romanian legal doctrine dealing with the issues of human assisted reproduction, in vitro fertilization techniques and techniques having equivalent effect or derived from it, dealing with the treatment of the subject from the perspective of criminal law. This paper is a review of the second edition of the volume published by Alexandra Huidu at LUMEN Publishing House in Iasi.

Socioeconomic Dynamism and the Growth of Baby Factories in Nigeria

Illegally breeding babies for marketing purposes otherwise known as “infant commodification” is increasing in Nigeria. This menace is a vice that threatens the lives and wellbeing of babies, young girls, and women. This article investigates through an in-depth review of scholarly publication and media coverages the factors that have contributed to the emergence and growth of the illicit industry in Nigeria. It examines the role of cultural beliefs, social attitudes, and norms as well as the harsh economic conditions of the nation as factors playing pivotal roles in the continual growth of baby farming in Nigeria. Some of these sociocultural factors are social stigmatization of pregnancy outside wedlock, stigmatization of adopted children, and the importance attached to fertility and the demonization of childlessness. The article draws on Emile Durkheim anomie theory and Chambers dimensions of poverty to explain how breakdown within the nation’s socioeconomic structure has a concomitant impact in breading social vices. It concludes by recommending that there is a need to jettison stigmatizing sociocultural beliefs within the nation’s social fabrics. Responsive attitude toward family reproductive issues should be encouraged and finally the activities of health care providers, operators of nongovernmental organizations taking custody of babies and young girls be properly monitored. As well, stringent punishment be meted out to apprehended operators of these baby farms to serve as deterrent to others.

Alcuni spunti di comparazione tra diritto italiano e diritto ebraico in tema di maternità surrogata

SOMMARIO: 1. Il divieto di maternita surrogata nell’ordinamento italiano - 2. Diritto ebraico e bioetica - 3. “Crescete e moltiplicatevi”. Il precetto divino di procreare e la maternita surrogata nel diritto ebraico - 4. Conclusioni. Some starting points for comparison between Italian law and Jewish law on surrogate motherhood ABSTRACT: Recent scientific progress in reproductive biotechnologies implies significant transformations in terms of the value and culture of the concept of maternity, which is no longer attributable to the legal definition of “mother” offered by Italian civil legislation. Assisted reproductive technologies separate the reproductive aspect and sexual union of the couple, finally leading to the metamorphosis of the relational dynamics underlying the “family identity” and the birth of new types of biolegal contracts. The study sets out to compare the approach that the Italian legal system reserves for the phenomenon of surrogacy with that which has developed at the heart of Jewish law. The interesting variety of opinions of the rabbinical authorities, which express both the Orthodox positions and the more progressive ones, show how Jewish speculation around bioethical reproductive issues has led to a respectful comparison of knowledge and judgements of the minority opinions that enter, with equal dignity, into the legal debate and are enhanced by the absence of a superior interpretation.

Sexual and reproductive issues and inflammatory bowel disease: a neglected topic in men.

There has been considerable literature on sexual issues in women with inflammatory bowel disease (IBD), but relatively little attention has been paid to these aspects in men. To review the available literature and to provide the best management of sexual and reproductive issues in male patients with IBD. The scientific literature on sexual and reproductive issues in men with IBD was reviewed. Several factors, including surgical and medication treatments, disease activity, lifestyle, and psychological factors, may play a role in the development of infertility and sexual dysfunction and may negatively impact pregnancy outcomes. Proctocolectomy with ileal pouch-anal anastomosis increases the risk of erectile and ejaculatory dysfunction by up to 26%. A treatment with sildenafil can be effective. Sperm banking should be advised to young men with IBD before surgery. Both sulfasalazine and methotrexate may be responsible for reversible sexual dysfunction and infertility. Furthermore, sulfasalazine should be switched to mesalazine at least 4 months before conception because of a higher risk of congenital malformations in pregnancies fathered by men treated with this drug. Psychotropic drugs, frequently used in IBD, may cause sexual dysfunction up to 80%. Last but not the least, voluntary childlessness occurs frequently, mainly because of concerns about medication safety in pregnancy and fear of transmitting disease. Accurate counseling, and where necessary, psychological support can decrease any misperceptions and fears. Close collaboration between the gastroenterologist and the patient is recommended for the best management of these relevant, neglected aspects in men with IBD.

Komunikasi Sosial (melalui Smartphone) sebagai Sumber Informasi Seksual: Ancaman bagi Kesehatan Reproduksi Remaja

Smartphones and Gadgets are reliable, cheap and easy media for the youth in their search for information on sexuality and reproductive health related issues in the Millennium era. The youths at their adolescent age have not yet acquired sufficient knowledge to differentiate between right and wrong, which makes them vulnerable to the practice of trying and emulating new things that come their way. One such tendency is the prone of the youth to pre marital sex. Sex and Sexuality are no longer taboo, but on the contrary have become commodities, a problem that underscores the importance of education about sex and reproductive health. The family, which should be the bedrock on this, lacks sufficient knowledge necessary to play its role. The conveyance process is bedeviled by information, communication, and psychological gaps, which force the youths to make their own search for answers. The negative impact of all this is reflected in the rapid spread of HIV/AIDS, sexually transmitted diseases, KTD and abortion.

Use of Administrative Databases to Assess Reproductive Health Issues in Rheumatic Diseases.

Administrative databases, registers, and other sources of big data can be interesting sources to address important research questions on reproduction in women with rheumatic diseases. There are many different types of administrative datasets worldwide, and it is important to understand the type of data present and unavailable in each dataset, validity and potential misclassification of data, and the ability to link maternal data with infant data. This article discusses the advantages and methodologic issues associated with administrative database use for the conduct of observational studies on reproductive issues in women with rheumatic diseases.

Reproductive health issues and challenges for health system strengthening

Reproductive health issues and challenges for health system strengthening

Mother-daugther communication about sexual and reproductive health issues in Singkawang, West Kalimantan, Indonesia

While parent-adolescent sexual and reproductive health (SRH) communication is one potential source of information for adolescents, it appears to be inadequately practiced in Indonesia. Given that female adolescents in Indonesia are faced with increased sex-related risks, it is important to understand, from parents and adolescents' perspectives, how parents communicate about SRH to their adolescents. This study was designed to investigate parents and their female adolescent children's patterns of SRH communication in West Kalimantan, Indonesia. A total of 15 adolescent girls (ages 13-15) and 14 mothers took part in four focus group discussions. Fifteen girls, aged 13-15 and 14 mothers aged 25-45 years participated in the study, sharing their reflections on their communication about sex and reproductive health issues. The analysis technique used was thematic analysis, which is performed by refining key themes that emerge from the data. Data were collected from the focus group discussions. The four themes identified in this study are: (1) Infrequent communication on sexuality between mothers and daughters, (2) Mothers' tendencies to avoid to discussing SRH, or feeling ashamed and that it is culturally unacceptable to talk about sexual matters, (3) Body change during puberty is the major content of the mother-daughter communications, and (4) Both mothers and daughters need adequate information about SRH. The study reveals that communication regarding sexual and reproductive issues between parents and female adolescents is limited in Indonesia. The quality of communication on general topics between parents and their female adolescents is one of the important factors related to SRH communication between them. It is essential that Indonesian parents become better informed and skilled, so that they may be involved in the sexual and reproductive health education of their female adolescent children.

Perceived Advantages and Disadvantages of Sex Education in Young Women: A Qualitative Study

Background: Although the importance of sex education for the youth is well documented in the literature around the world, sex education remains controversial in Iran. Objectives: The aim of this study was to explore Iranian women’s beliefs and perceptions regarding advantages and disadvantages of sex education. Patients and Methods: In this qualitative inquiry, we interviewed 41 young women aged 18 - 35. Focus group discussions and individual interviews were used to collect the data. Conventional content analysis was used for data analysis. Multiple data collection methods, maximum variation sampling, and peer checks were applied to empower the rigor of study. Results: A total of 5 themes were categorized into 2 main domains: advantages and disadvantage of sex education. The first domain was conceptualized by increased knowledge, normalization of sexual and reproductive issues, and self-efficacy; the later domain by: motives for initiating sexual behavior and tainted modesty. Conclusions: Since most young women believed that sex education is beneficial for them, an effective, appropriate, and culturally-approved program could be designed for sex education.

De la “mujer moderna” a la “mujer liberada”. Un análisis de la revista Claudia de México (1965-1977)

Este artículo analiza la revista femenina Claudia de México, desde su aparición en 1965 hasta 1977, cuando se pone en marcha el Programa Nacional de Planificación Familiar (1977). Claudia se presenta como la revista para la “mujer moderna”, interpelándola a partir de la moda, las recetas de cocina, las publicidades, y con informes que abordan cuestiones sexuales y reproductivas, como el placer sexual, la anticoncepción y el aborto. A comienzos de los setenta, las consignas de “liberación femenina” ganan lugar y aunque criticadas, van marcado una nueva época en la cual las políticas demográficas mexicanas apuntan a sostener el derecho de las mujeres a decidir en materia reproductiva y a erradicar el “machismo”. El artículo se organiza a partir de esta transición, y combina un análisis en profundidad del contenido de la revista (notas, fotografías, publicidades) con otras fuentes, como el cine de la época, escritos feministas de la segunda ola, entrevistas a mujeres jóvenes en aquellos años, y bibliografía secundaria que aborda este periodo.